2017 Public Health Grand Rounds 03/03

PUBLIC HEALTH GRAND ROUNDS Linking Research to Community Health Improvement Jointly sponsored by the Department of Public Health Sciences & URMC Center for Community Health

- And ways the two can intersect.
We have a wonderful speaker today that emulates that.
I should go this way.
To the nines, so, thank you.
If you have ideas for future speakers,
please be sure to write them on the evaluations
that you should have grabbed on the way in.
If you didn't, please grab an evaluation.
We really do appreciate the feedback on the speakers
and appreciate any comments for future speakers
and ways we can improve Public Health Grand Rounds.
It is my pleasure today to introduce today's speaker,
Dr. Norbert Goldfield.
Dr. Goldfield is the founder and executive director of
Healing Across the Divides, a 12-year-old organization
seeking to improve the health
of marginalized Israelis and Palestinians.
He also works as Medical Director in Northampton,
Massachusetts, for a private research group,
developing tools aligning payments to improve quality.
Dr. Goldfield is a board-certified internist,
practicing at a community health center
in Springfield, Mass.
He edits a peer-reviewed medical journal,
The Journal of Ambulatory Care and Management,
and has published extensively on topics related
to health care quality, financing,
and peace-building through health.
Please welcome me in joining Dr. Goldfield.
After our session today,
we will have a question-and-answer time down
in the Fiaretti Room in the hallway
in the Nursing Center, so if you have questions afterwards,
feel free to join us for that Q&A as well.
So, Dr. Goldfield.
(audience applauds)
- Everybody hear me?
Everybody in the back?
I was born in Italy and I'm Jewish,
so they asked me when I first walked in is,
"Do you want to speak from the lectern
or do you walk around?"
Well, it's an oxymoron, I'm Italian and Jewish,
that I must walk around and use my hands,
(all laugh)
and so forth.
Before I get in, I just wanna personally thank a few people,
Dr. Greene, Dr. Fusella, Dr. Zahn, Dr. Lee,
and all of you for coming.
It's really been a pleasure and an honor
for me to come back to the University of Rochester.
Some of you already know this.
I actually graduated from the University of Rochester
in 1972, before most of you were born, (laughs)
to make it simple, and I have not been back since,
so it's just great to be back.
What I'd like to do is speak for about 20 minutes or so
and then then open it up for questions and discussion,
and then hopefully we'll continue the conversation
in the room that Dr. Greene alluded to.
It's actually at some level depressing,
but let's get right to the chase.
Here is the Democrat and Chronicle of today.
Vandals damage Jewish cemetery.
What does that have to do with Healing Across the Divides?
Let me tell you my perspective on it.
Again, we can talk about this at length afterwards.
This is from today's Rochester newspaper.
Vandals damage Jewish cemetery.
My father and my mother, if they read such a title,
I don't even wanna get into it,
because it'll get me emotional.
The reason why this is important is
because that the fact that, whether it's Jews,
whether it's Muslims, whether it was two Indian people
who were mistaken for being Iranian
who were killed last week, the reality is, not only,
and I'm gonna be very direct here,
and I'm happy to dialog about this,
but not only has this administration not been willing
to confront it, and now I'm gonna quote
what was reported in the newspaper,
so it's not a direct quote, that President Trump said
that these attacks are false flags,
it's actually didn't even know what it meant
until I looked it up, that false flags are actions
that are being taken by, in this case, Democrats and Jews,
to bring a bad name to this administration.
What does that have to do with Healing Across the Divides?
The reality is, is that the Jewish community is not unified
on this issue.
Just so you have a flavor, that what the divide is,
and this has everything to do
with Healing Across the Divides, because it does lend itself
to the Israeli-Palestinian conflict, which is to say,
that historically, until pretty recently,
you could have a perspective
on the Israeli-Palestinian conflict
and you could put it over here, if you were Jewish,
and then you could engage on other social issues
and really work strongly on issues of civil rights
or whatever, and move ahead on those,
so you could separate the two.
Those days are gone.
They've been accelerating and those days are, right now,
they're completely gone, because what happens is
that the Jewish community is split,
the organized Jewish community is split between individuals
who say, "This is unacceptable," unacceptable, okay,
versus those, and there're major Jewish organizations
who believe that, that we should not make a big deal
out of it, why, because the current administration
is pro-Israel, and that's what all that matters.
Again, I'm not gonna get into, and I'm not interested,
in the issue of what means pro-Israel
or what's not pro-Israel and so on and so forth,
because that's not what you came to hear,
but I want you to know very clearly
that this is a profoundly disturbing headline
in today's newspaper and it's reflective
of the split within the Jewish community.
Why is that important?
Because it does impact the way the United States behaves
towards the Israeli-Palestinian conflict,
because I'm sure that many of you, at least Americans here,
the ones who have lived in the United States for years,
know that the American domestic opinion does make an impact
on American foreign policy.
As a consequence, that split
between the American Jewish community
of the what I just described, does have an impact
on the behavior of the current administration
with respect to the Israeli-Palestinian conflict,
so that's what it has to do
with the Healing Across the Divides.
Within that spirit, with that frankly depressing, for me,
having to start out this conversation with that notion,
the reality is, is that Healing Across the Divides operates
at a completely different level.
What I'm gonna try to do today is provide
some general comments on peace-building through health,
and then I'm gonna summarize our experience
over the last 13 years.
There's a difference between peace-building
and peace initiatives.
Peace-building through health as a concept
was developed in the '90s,
particularly at the World Health Organization.
Here's my plug for Italy; I was born in Italy.
Italians have had a very strong engagement
with the whole peace-building through health movement.
Either they're for peace-building
or the times that they've been engaged in wars,
Italians are not very good at wars historically,
so they're not very good fighters.
This is my plug for Italy, which I love dearly.
We've had a significant engagement on peace-building.
Italians really talk about peace through health.
I don't believe in peace through health.
I believe in peace-building through health,
which is to say that peace is a political process.
The work that I'm gonna describe to you has some ingredients
of aspects of politics, and you will see those
as I describe them to you, but at the end of the day,
peace is a political process, as you just see here.
By the way, you'll have copies of all these slides
and you can do whatever you want with it.
Benjamin Disraeli, who was a Prime Minister of England
in the 19th century, who comes from a Jewish background,
he said that the health of the people is really
the foundation on which all their happiness
and all their powers as a state depend.
At the end of the day, that's why I'm a health professional.
I would assume the vast majority
of you are also health professionals and some aspect
of this is what motivates you.
What is some recent trends
in the Israeli-Palestinian conflict?
Bottom line is, there's a decreasing cooperation
between Israeli Jews and Palestinians on the West Bank.
Where there is cooperation,
it tends to be either one-sided
and/or cooperation between groups
that are somewhat marginalized by their own societies.
We are actually a founding member
of an organization called Alliance for Middle-East Peace.
You can read through the rest of this
as I make some comments.
Alliance for Middle-East Peace,
which is an American organization,
of approximately 90 organizations,
which has either American or Israeli Palestinian groups
that brings the two sides together.
The reality is, when I say one-sided,
it's essentially being Israeli organizations
that provide technical services
to Palestinian organizations, or where there is cooperation,
most of the groups are fairly marginalized.
What do I mean by that?
What do I mean by that, to be absolutely crystal-clear,
is that most Israeli non-governmental organizations
cannot meet quote unquote the acid test of most
of the mainline or main Palestinian NGOs.
Not to talk about different individual levels
of cooperation, which do exist, but what's that acid test?
The acid test is that that Israeli organization must say
that the occupation of West Bank and Gaza,
and specifically the West Bank,
is at the heart of Israeli-Palestinian conflict.
Most Israeli organizations cannot do that, they perceive,
because of the fact, if they do that,
frankly, much of their funding would dry up,
whether it be from Israel, whether it be from American Jews,
or whatever, that's the challenge
that we've come up against.
I'm not putting any value judgment on that,
I should be clear.
I'm just saying, as a statement of fact.
Some introductory comments continued,
in terms of the Israeli-Palestinian conflict.
You can read through these slides.
It's hard to believe.
This conflict, it depends on how you count it,
has been going on for at least 75 years.
That's a kind of a long conflict,
one of the longest conflicts that exists
in the world today, if not the longest,
and I just don't know.
There may be other conflicts that are longer,
but you can see here some of the points
that I'm trying to make.
These are issues that you can think about,
you can reflect on it, but from our perspective,
and when I say that, I say that as somebody
from Healing Across the Divides,
that conflict-sensitive health interventions can produce
lasting tangible health benefits.
That's one of our premises.
I'm gonna get into more details as we go forward.
Today in Israel and the West Bank,
just so you get some concrete ideas,
there are Bedouin who are living in Israel
and the Bedouins often don't think of themselves
as Israel Arabs, some people do,
sometimes Bedouin think of themselves as Israel Arabs,
but one of the things you should know as an example,
for those of you who are not deep into this issue,
that many Israeli Bedouin men serve in the Israeli army.
Israeli Arab or Israeli Palestinian men do not serve
in the Israeli army, almost as an absolute fact,
but just as an example.
Bedouin living in Israel have little to no access
to health services, together with Bedouin women
who have high rates of violence perpetrated against them.
You may have some questions about that
and I can discuss that in some detail.
Ultra-orthodox Jewish women,
who have lower mammography rates than other women in Israel,
talking about Israel now, together with high rates
of accidents with their children at home.
Ultra-orthodox is about 20% of the population.
Israeli Palestinians or Israel Arabs is another 20%
of the population in Israel.
Overall population approximately eight million.
The rest of them, 60%, are largely Jewish,
with some small numbers of Christians.
Palestinians living in the West Bank near Hebron,
with post-traumatic stress disorder,
living under constant fear of attacks by settlers living
in a nearby new Israeli settlement, it's called Susia.
Some of you may see information about Susia in the news.
The bottom line is that the Israeli government would like
to dismantle the encampment or village that's there,
which would allow for the expansion
of the Israeli settlement in Susia.
There are tens of thousands
of African refugee asylum seekers who are exposed to HIV
or who have been exposed to HIV and do not have access
to the prevention and treatment that is needed.
Just so that you have a sense about between 50
and 70,000 African refugee asylum seekers,
these are Africans from Eritrea, Ethiopia, Sudan,
who made it through the Sinai and got themselves
to the Israel, who are living largely in the Tel Aviv area,
which is one of the largest cities there,
and there is a significant need for services.
Not too atypical, except for the fact that,
well, I will stop there.
Not too atypical from what's happened
to many undocumented people in this country.
Palestinians living in the West Bank,
with high rates of diabetes and obesity,
with little access to treatment.
From my perspective, to be effective
beyond direct health benefits,
one must take the long-term perspective,
and not just swoop in and be the America expert with money.
That's one thing that I wanna emphasize
to you as our perspective.
You'll see that in some examples in just a few minutes.
A couple introductory comments as to what's our role
in terms of peace-building through health:
Clearly, we talk about communication of knowledge.
Just as an example, we have an intervention pertaining
to post-traumatic stress disorder among women in the area
that I told you about, in this area called Susia.
We had a colleague from the University of Pennsylvania
who went and did three days of training in exposure therapy
for mental-health professionals,
25 to 30 mental-health professionals,
and that's communication of knowledge.
Healing of the individual
and society are strengthening communities.
We have a representative in Israel.
We have a representative in the West Bank.
Both of them have decades of experience working
with community groups.
In addition, our representative
in Israel is the longest surviving person with HIV
in Israel, probably one of the longest surviving
in the world.
He's had HIV for almost 30 years.
He's a very well-known community activist.
He's passionate about the work that he does
as part of Healing Across the Divides.
Personalizing the enemy is another technique
of peace-building through health.
The reality is, from my perspective,
we've been completely unsuccessful.
The stories that we tell.
There's so much animosity at this point between,
let's shall we say, Israeli Jews and Palestinians,
between American Jews, many American Jews,
not all American Jews, obviously,
but many American Jews and, shall we say,
American Palestinians or American Arabs.
It's very hard to personalize the enemy these days,
so I'd be happy to respond to comments.
What's our mission?
We are an American 501(c)(3).
Our mission is to improve the health
of marginalized people living in Israel
and the occupied Palestinian territories
via community-based interventions.
I use the word occupied.
This is the word that the Board decided on,
which is both Jewish Americans, Arab Americans,
and regular Americans, just people who are just interested.
I use it advisedly; it's in our mission statement,
but the reality is, occupied doesn't mean
who should be occupying whom,
it's just that there are Palestinians living there
in the Palestinian territories, and there is an ongoing war
between Israelis and Palestinians.
What we do is we believe that, with the outside
of healthcare professionals like myself,
we can work on concrete societally based health problems,
such as diabetes or breast cancer, I can give examples
of that, we can do research in an applied manner,
so everything has to be measurable and has to be evaluated,
and we can identify issues that are resolvable
by the parties, the community-based groups,
coming to the meeting and joining forces
to form a common strategy to tackle the problems,
or to put it differently, one of the wonderful things
of my coming over the last two days is that,
as Dr. Greene alluded to, I do a lot of work
on healthcare reform in this country
and I'm one of several hundred people, there's many of us,
that does impact healthcare in this country,
hundreds, but you know what?
There are about 10 or 15 people who can make a difference
in the Israeli-Palestinian conflict, and you know what?
I'm not one of them.
That's the reality, so I may be a fool,
but I'm not delusional, to make it simple.
I feel morally compelled as an American Jew,
to be engaged in the Israeli-Palestinian conflict.
I work from the bottom up.
These are community-based interventions,
you'll hear a little bit more in just a minute,
that meet these three criteria.
These issues are not pie-in-the-sky issues.
They have to be concrete, they have to be ones
that can be evaluated, and they have
to be issues that are resolvable.
What we've done is, we're tens of thousands of people,
we've documented the improved health status
of the population served,
and we've made an increased awareness on the part
of policymakers, and I'll give you some examples.
We bring one leader of one of the community-based groups
to the United States every year, and you know what?
Theresa, my dream would be that, or Martin, or Kevin,
that my dream would be that later this year,
when one of them comes, that they could come
to Rochester and give a presentation.
Examples of cooperation:
Remember I said we had these interventions.
We're currently funding about 10 interventions.
The grants are three-year grants, and again,
things will come up.
We bring the groups together in Israel.
We bring the groups together in the West Bank.
In general, but it's not exclusive, most of the groups,
I've already alluded to this,
in the West Bank are not willing to meet
with the groups in Israel.
Within Israel, there're both Jewish groups
and Israeli Arab groups.
Here are examples of some of those cooperation
that you've just read through,
and I'd be happy to give you more detail.
In the Palestinian territories, there's cooperation
between two organizations right now,
between the Family Defense Society and Caritas,
both of which have implemented Kate Lorig's work,
chronic disease self-management, that is a,
as far as I'm concerned, a pioneering effort with respect
to chronic disease self-management,
that I became a master trainer in the last year.
Sustainability, you're gonna ask me about that,
so let me address that right off the bat.
Our grants are three-year grants.
By the middle of the second year, the community groups need
to start to think about an exit strategy, which means,
to be practical, is that Israel has a healthcare system.
The United States has a healthcare system.
That's a good thing.
The bad thing is that Israel
and the United States has a healthcare system.
It's because we have some concerns
that some of us have talked about.
There's opportunities for improvement.
The West Bank and Gaza does not have a health system.
It is not even a country; it is a territory.
Let's be clear, it is not a country.
It has many health systems.
I had the wonderful pleasure of being to the first
and last meeting I'm sure I'll ever go to,
I had to get permission from the Board,
for a meeting that was organized by the CIA.
The CIA meeting was about,
there were about 20 of us in the room.
They said, we understand that
there are all these different mini health systems,
each of which is operated by a different political party,
because in case you don't know this,
and I'm sure you do know this,
healthcare is very labor-intensive,
so it's a great way for political patronage.
That's the bottom line.
They asked my advice and other people's advice
as to how to strategize with respect to USAID grant
that was eventually about to come.
Not surprisingly, they decided not to go down the road
that we would have adopted, which was,
as you already assuming Martin and Kevin
and Theresa know me, I said we should pay
for better outcomes, but instead
what they did was also rational.
They wanted to strengthen the established political party,
which is the PA or the Palestinian Authority,
and also known as Fatah, and they gave them $100 million,
and guess what?
The USAID basically wasted their money.
That's okay; life goes on.
In the West Bank, I've already said
and I'd be happy to respond to questions,
that the Palestinian economy is a donor economy
in a territory, not a country, and I can talk to you
about sustainability after we go through the thing.
In this session I've attempted, and we're beginning
to close down so you can start thinking of some questions
to address these fundamental questions.
Realistic objectives of a peace-through-health initiative
beyond health itself, yes.
Only if it's done on terms acceptable to both sides.
That's our perspective, big-time.
I'm sure there'll be question, how do we fund proposals,
how do we find proposals, and so on and so forth.
It has to be on terms acceptable to both sides.
Communication cooperation, yes.
I've already given you some examples.
There are more examples that I can give you.
Is this a subject to evaluation or assessment?
We are not interested in funding any initiative
that is not possible to be evaluated, period.
We've had lots of colleagues, and I look for as one
of the benefits that I hope, frankly,
to get out of my coming to Rochester,
is new colleagues that we can work with,
such as my colleague from UCLA, who did an evaluation
of a drug-abuse prevention intervention
that we have funded now in East Jerusalem.
In what ways, if any, can we say
that health programs contribute
to long-term political stability or peace?
It's my perspective and our perspective,
interventions that focus on community-based improvement work
from the bottom up, and can meet, in quotes,
in a mutually reinforcing manner,
political changes coming from the top down.
That's how we look at it.
How does all this change in different contexts
in this conflict?
Is the political situation overwhelming the health issues?
As far as I'm concerned, now is the time.
It's even more important to do this kind of work.
We must seize the moment to see
what we can do in the next 12 months.
From my perspective to the decreasing cooperation?
We foster cooperation between Palestinians in Israel
and in the West Bank and soon Gaza.
We use this as a bridge to Israeli Jews.
What, with respect to the divide
between rich and poor within Israel, etc.?
We provide avenues of cooperation
between disadvantaged Israelis,
for example, Ethiopian Jews and Israeli Palestinians,
and via this, between Israeli Palestinians
and Palestinians in the West Bank.
We foster measurably concrete improvements in,
for example, women's health.
Lastly, we aim, and it should be clear by now,
we aim to strengthen the private,
secular NGO sector and encourage transparency
between all Palestinian health sectors.
These are all pregnant with questions
that I'm hoping you're gonna ask me.
What about Trump?
I'm gonna address that right up front.
From my perspective, Israelis have decided
to maintain a significant presence in the West Bank.
I don't put a judgment on it.
I don't say yes, no, whatever.
For a variety of reasons,
which also can generate some questions,
the Palestinian Authority is unlikely
to demand any changes in the current state of affairs.
Looking to the United States for leadership has not been
and is likely not to be productive,
but of course, we should always try.
That's how I started today, with that headline
from the Democrat and Chronicle.
The work of Healing Across the Divides
with community-based groups results in, at a minimum,
measurable improvement in the health for many individuals,
at this point, tens and tens of thousands
of individuals by now.
My hope is that our work with grantees will result
in greater effectiveness on the part
of the community groups and its leadership that we fund.
We can only strive for the day that some
of these community groups will be tomorrow's leaders.
After the election of Trump, I am all the more convinced
of the validity of this (audio skips).
As you read this last slide and begin to think
of your questions, I just wanna give you an example.
Last year, we had an individual who was the leader
of one of the Israeli Arab groups that we fund,
a very strong woman who calls herself a Palestinian living
in Israel, so she doesn't call herself Israeli,
she calls herself a Palestinian living in Israel.
That says something about what her attitude is.
She came, gave speeches, she was
at the Harvard School of Public Health.
I'd love for somebody like that to come here next time,
and so on and so forth.
She's at the State Department, the Carnegie Endowment,
and in addition, we're always looking for partners.
I'm hopeful that there'll be a partnership
between ourselves and some groups in Rochester.
We currently have a partnership with the UNHCR,
with the African refugee asylum seekers.
UNHCR stands for United Nation High Commission Refugees.
We have had a partnership
with the Cleveland Jewish Federation.
They're out of the healthcare quote unquote business.
They put in a million dollars over three years.
This leader went to Cleveland and spoke.
I already told you a little bit about her.
The Cleveland Federation, to put it in a positive way,
would say something like, well,
this was an op-ed piece a week or so ago
from the Jewish leader of the settlement in Hebron,
he would say that there are five options for Palestinians,
and the one that he would support would be
that all Palestinians would leave the West Bank and Gaza.
There was a lot of those people in Cleveland.
To a person, they all said the dialog was a great dialog
between these two fundamentally different perspectives.
That's what Healing Across the Divides tries to do,
but you know what?
As Kevin for sure knows, I am a greedy guy.
I wanna have measurable improvement in health first,
because you know what?
I'm not waiting for the day that peace happens,
so I wanna see measurable improvement in health.
That's what I can contribute to the equation,
and with your questions, I'm sure we can sharpen the focus
and thanks so much for having me again,
Dr. Greene, Dr. Fusella, Dr. Zahn, and so forth.
That's it; open up for questions.
Yes, if you could just say your name.
- [Questioner] I am (mic lost words).
When you talk about measurable improvement (mic lost words)
How do you measure (mic lost words)
- That's a great question.
The question, in case anybody didn't hear it,
was how do we measure improvement in health.
It depends on the initiative.
Let me just give as an example, I alluded to the fact,
and I'll give you one example in the West Bank
and one example in Israel.
With respect to the West Bank,
we're funding an initiative with an organization
which pertains to chronic disease self-management.
It's using the Kate Lorig model,
where I became a master trainer,
the manual that Kate Lorig developed, has been translated
into Arabic and validated.
It's actually never been used in the West Bank or Gaza,
but it's been used with other Arabic-speaking populations,
so there's a manual.
The intervention is to chronic disease self-management,
and I'd be happy to describe it a little bit further.
There's a couple ways that we're looking at improvement.
We're using some aspects of the Dartmouth COOP Charts,
as some of you may be familiar.
They're fairly simple, they have pictures,
there's a fair percentage of illiteracy in several
of the populations in both Israel and the West Bank.
It's some patient-reported measures.
In addition, there's a percentage of those patients
who will also have some laboratory tests, hemoglobin A1c,
and so on and so forth, that will also be tracked.
In Israel, there's an intervention with the UNHCR,
the United Nations High Commission Refugees,
where we're looking at, with respect to family planning,
which is actually quite complicated
among the African refugee asylum seekers,
since many of the women who came
through the Sinai were sexually trafficked.
What we're looking for now,
we're training the change agents,
and then the change agents then will work with individuals.
The change agents, we're looking at their knowledge
and we're looking at their behavior for themselves,
to see before and after the training, and then we will look
at the impact on the individuals themselves.
In essence, we're looking at a combination
of patient-derived measures, or again, I apologize,
I shouldn't have said patients,
I'm a physician, so consumers, participants,
however you wanna frame them, so participants,
and some what I'll call traditional laboratory measure.
Another measure, and then I'll stop, is sustainability.
Some of our programs have been taken up.
There was a program, especially by the Israeli government,
one of our programs that increase mammography rates
among ultra-orthodox women,
was taken over by two of the HMOs
in Israel, another intervention pertaining to exercise
and diet among young mothers was actually taken over
by the Israeli government and the (says Hebrew name) set
of centers in several parts of the country.
That's another measure of, shall we say, success,
but I wanna be clear.
Some of our programs have failed
and we have pulled grants before.
Yes? - I wonder if you might-
- Can you just say your name?
- [Marsha] My name is Marsha Lincoln.
I'm in medicine (mic lost words)
The sorts of things that you're looking at (mic lost words)
Trying to improve (mic lost words)
Examples that are so (mic lost words)
And obviously, anything political is (mic lost words)
As well, so I wonder how you're measuring some of those,
particularly (mic lost words)
Opportunities there (mic lost words)
- The question was, social determinants of health
and the impact that that has
on the measurement that we're having.
For sure, we're looking at two approaches.
Number one, we're looking at just time, over time, changes,
for example, changes in mammography rates over time,
the changes in weight and so forth,
all of which are very much modified
by social determinants of health.
We're also looking at, just to introduce another area,
is when we bring the groups together
to see to what extent they wanna work together.
We don't insist on it.
We give them opportunities.
Some of them do work together and I've already alluded
to the fact that some of them don't work together.
The reality is that, I guess, our perspective as to ways
to address the issue of the social determinants
of health is to say that it's important
to have a community group that we're funding
that has an established presence, so that's A,
so that in the community.
We have an intervention that works
to decrease domestic childhood accidents.
Last year was with Israeli Arabs.
It's actually through training grandmothers
to go from house to house to decrease,
through an evidence-based checklist from the Cochran work
as what works and what doesn't work.
Now it's being implemented
in the ultra-orthodox Jewish community.
There has to be a community group.
It also has to, in some way,
incorporate who are the change agents.
The classical paradigm of the doctor-patient relationship
is clearly not working for any of that groups
that we're talking about, so there's some challenge there.
Our challenge is to document the benefit of this effort
so that the entity, in this case, most notably Israel,
which is a first-world country, some segment
of the Israeli economy might wanna take it over.
It's a combination of working with community groups
that are established in the community,
in conjunction with understanding interventions,
because we don't start new interventions
for which there's no evidence base,
so it has to be an intervention
for which an evidence base exists, and then working with,
in some aspect, with community change agents,
who by the second your somehow have
to interact with the healthcare system.
Yes?
- [Questioner] So, you've mentioned that the grant
is three years and (mic lost words)
and assisting with the proposals for the problems
in the West Bank.
After two years, how they will provide?
- Most of the time they don't, so just to be clear.
That's why I became a master trainer
in the chronic disease self-management.
The hypothesis is there that with the payment
of one community health worker,
then I'll give you another example, that that person,
together with a small stipend to the village health leaders,
these are community people who live
in five different villages,
that's what the intervention is for the first year,
will eventually impact approximately 750 people
within the community who have a chronic illness.
In the expe- (audio skips) to make it appealing
to an entity that could be either a donor,
which is primarily the European Union
or the Arab Gulf States slash Saudi Arabia,
who basically support the Palestinian economy,
to be interested in taking it on.
The other thing that we do is, very early on,
we don't wait 'til the end of the second year
to get engagement with the, in this case,
the Palestinian Ministry of Education,
the project that I'm gonna just describe to you.
I mentioned to you that we do an intervention
with drug abuse prevention in East Jerusalem.
Very early on, in the first year, the Ministry of Police
and the Ministry of Education was made aware of the program.
By now, they're quite familiar with the program,
and we're hoping that in year three,
we will go beyond East Jerusalem and hopefully
that the Ministry of Education will be
sufficiently interested, so that even
in year three they will start
to think about implementing the program
in different parts of the West Bank.
Yes?
- [Questioner] Do you think that this university in the,
at the universities in the West Bank, (mic lost words)
People who would (mic lost words).
- The question was, what about universities
in the West Bank.
The short answer is, no, and at the end of the day,
it's that some of the challenges that we, thankfully,
that we talked about this morning and yesterday,
it's really the town-gown relationship.
That highlights the way we approach getting initiatives
and getting proposals.
We don't go and knock on a door and say,
"Hey, you want some money?"
That's not the way we operate.
We will either do a solicitation
or we will do a solicitation for proposals in the West Bank.
We will send out a notice; we will put out a notice
in the newspaper; we will go through any of our contacts,
ask them to write a one-page proposal.
From that, we will, let's say we might get 30,
we will shape it down to 10.
We're not a typical foundation in the sense that,
if they can get it through the one-page proposal,
we bring them together and tell them the elements
of what a very successful proposal might be,
and we work with them and try
to help them make the best possible proposal,
and then, from the 10, we might fund two or three or four,
depending on what kind of funds we have available.
We have only gotten one proposal from a university,
one proposal from Al-Quds, and it was really,
to put it in a positive way, not appropriate to be funded.
If you have contacts, I am always happy to look at that.
I'm hopeful, we just started a grant,
we just started an initiative in Nablus, which is north
of Ramallah, Ramallah being the capital of the West Bank,
a lot of refugee camps everywhere
throughout the West Bank and Gaza,
refugee camps, but not the way you might see them.
It's like the Syrian refugee camps.
They often have ramshackle buildings, 'cause they've been
in existence, formalized refugee camps, since 1948,
but I'm hopeful, in Nablus, that we might be able
to have some relationship with Al Najah.
It seems like the project is going reasonably well.
When we go there, when we're there in March,
they will have been in effect for the last five months,
and we'll see what transpires.
I wanna make sure that other people who haven't had,
otherwise I'll come back to you.
Yes?
- [Questioner] In order to apply, do you have
to have two partnerships coming together?
- Not necessarily, no.
They can be individual, and I apologize
if I gave you that misimpression.
It's a community-based groups that applies,
and then, once they get funded, then we bring them together
to see if they wanna work together
in whichever way they want to.
I apologize if I said that, if I gave the misimpression,
it's a community-based group that applies for itself.
It has happened, by the way, not very frequently,
but it has happened where two community groups
will apply together.
It's happened a few times, but it's not the dominant mode,
but what we see our role is, is to bring them together.
Just so you know, we funded a program
with physically handicapped women in Israel,
and there was a joint effort
between an Israeli Arab organization
and an Israeli Jewish organization.
We're funding an effort on HIV,
the African refugee asylum seekers,
and that also is a joint project between two org.
Most of the time, it's an individual group,
and that, for example, Qayan, which is an Israeli,
the leader that I was telling you about
who went to Cleveland, they started on their own,
but they started then to work
with an organization called One in Nine,
which is one in nine women getting breast cancer,
to work together, and that was facilitated by us.
- [Questioner] As a follow-up, what have you learned
about when these partnerships work and when they don't,
and how have the Muslims been feeling,
having to do things differently?
- That's a very good question.
Again, what are the lessons learned
from the community groups working together?
What we did learn is that it's very important that,
if the community groups work, they have to have,
it goes back to the point that I said today,
earlier in the presentation, about the relationship,
which is asymmetric when Israeli medical organizations
do work in the West Bank.
It's an asymmetric relationship.
If it's to work long-term, the community groups have to
both have a certain strength, that it can't be
where one community group is very weak,
the other one is stronger, inevitably resentment builds up,
I can tell you, right off the bat.
Our role is to be very aware of that fact, and to, frankly,
not fund that type of relationship.
Other questions; yes?
- [Questioner] It's amazing to me how we're talking
about Israeli-Palestinian relationships,
but you could just as easily say,
academic versus community relationships.
All the analogies (crosstalk obscures words).
- We're human beings, folks. (laughs)
We may be at war, but we're still human beings
who all desire health.
- Yes. - Yes.
- [Questioner] In my experience working with the community,
there's a community health positive building something
that happens when groups that normally don't work together,
work together towards anything,
whether it's breast cancer rates
or violence in the home or whatever.
Have you done any measurement
or can you suggest any measurement?
I just was at a AMC conference where we were talking
about measuring hope or measuring I-don't-know-what-that-is,
resilience, certainly, but that's been done,
but all the community, when they're working together
on something (crosstalk obscures words) of that community.
- There is two things.
There is a whole literature on the resilience issue,
and definitely this is not the time or the place,
but there is good research on that.
I'm definitely a fan of that,
but also, the part of the question
that you brought up raises another point.
Let's not forget: Healing Across the Divides
is an American 501(c)(3).
One of the oftentimes things that happens is
that people say, "Well, we'll form a group,
"but we're starting with this individual."
That's okay in the United States, and you know what?
I have formed groups myself.
I'm sure some people here have formed groups,
but that's within an American context.
We only deal with established groups.
That's an important premise,
because we are coming from the outside.
We're Americans.
It's not atypical, frankly, for Americans,
in terms of their foreign policy,
"Oh, we like you; we'll make you President."
That's a time-honored style.
Sometimes it works and sometimes it doesn't work.
I'm just making the point that we are an American 501(c)(3).
If I was living in Israel, if I was living in the West Bank,
just like our Israeli representative, he started a group.
He himself started a group
that deals with physically handicapped people.
That's great, but I just wanna be sure
that we have to always be careful, from a moral
or ethical point of view, that we don't start groups,
which could absolutely happen and should happen.
For example, it does happen in Rochester
or Springfield or whatever.
Obviously, a group starts with somebody,
or it's a group of people coming,
but we have to be working with an established group.
The research on resilience, and it's an interested question,
I guess what I would say is,
we're not set up as a granting organization
that gives grants for three years.
It'll be an interesting question if we got
into a relationship with an organization
where we could do it for a seven, eight, or nine years.
I think that would be interesting to see
if we could measure resilience in the population
and to see what the strength is.
We are de facto doing that in Susia, the encampment,
but that's with the women that are being dealt with.
There, the post-exposure therapy with the women
and the teenage girls, is exactly
to strengthen their resilience,
both against domestic violence and settler violence.
I don't want you to feel disappointed,
so you had a question.
- [Questioner] I think you answered my question.
My question was on the birthrate, that you mention payment.
If you have a conversation with (mic lost words)
- Right; why do projects fail?
Any number of reasons.
The reality is that, not infrequently,
the organization is just not as strong
as we thought it was, very simply.
It's not terribly profound.
Even though we have representatives
in both Israel and the West Bank that make site visits,
I make site visits, but you know what?
As you can tell, im human, who make errors.
Also, the other thing I can tell you right now
is a big barrier, both Israeli
and Palestinian organizations are just used
to getting money shoveled at them with no accountability.
Working with us, I can tell you, by reputation,
we are thought to be very, very intensive.
The relationship with us is, with some people,
is too much to manage, because, hey, if I can get 10,000,
20,000, 50,000, whatever, our grants range from 10,000
to 100,000, without basically having to do anything,
that sounds like, almost like this group.
Whew, I shouldn't have said that. (laughs)
At least I can laugh at myself.
Yes, please?
- [Questioner] I just was wondering if you knew
about any school where you can find other (mic lost words).
- That's a good question.
In case you didn't hear, are there other areas,
other organizations similar like ours?
The first thing I wanna say is,
I don't like starting organizations.
I always see myself as being part of a team,
and we've talked about that, many different,
how we're part of a team, a team is really effective.
Being a lone soldier is not possible.
The reality is, there is no organization like ours
that both funds Israelis and Palestinians.
That has a negative, by the way,
I wanna be very clear about that,
because especially today, in the polarized environment
that we're living in in the United States,
the reality is that, increasingly,
American Jews do not wanna support anything
that funds the improvement of health
of any Palestinian anywhere,
and the same thing goes for Palestinians.
There are all these what are called Ramallah clubs.
Our Palestinian representative,
her parents live in San Francisco.
Our Palestinian representative chose
to raise her children in the West Bank.
She finds, even though there are all these checkpoints,
she finds life to be much calmer than it is
in San Francisco, and she wanted to raise her children
in a Palestinian area.
She once spent the summer in San Francisco.
The Ramallah clubs would not meet with her,
because some of the moneys that we fund,
clearly and explicitly fund Israeli Jewish organizations.
That said, I formed Healing Across the Divides
because there was nothing else out there.
I felt that I, myself, must be engaged somehow
in the Israeli-Palestinian conflict,
and that there was nothing else out there.
I am sure there are other organizations like that.
We just joined, actually,
a group called The Council on Foundations, and I hope
to meet some like-minded organizations, but in any event,
that's why I formed Healing Across the Divides.
Yes, please?
- [Questioner] I think I probably just missed this,
but where does your funding come from?
- Ah, no, you didn't miss it.
There's a little bowl at the back there.
(all laugh)
All kidding aside, the funds come from donations,
individual donations.
That's certainly a big part.
Partnerships, and when I say individual donations,
clearly from people like yourselves and myself.
I work part-time, obviously, as part of that,
but I'm unpaid.
We will just see over time how sustainable that is,
'cause clearly I'm not gonna do it forever,
but the bottom line is, individual donations, partnerships.
We did apply, I'm sure some of you have heard
about the $100 million award from McArthur.
We didn't get it, not surprisingly,
but we did pass it through the first round.
It's a very cool project.
We have this project, which I've already alluded to,
where we train grandmothers as agents of change,
to decrease childhood accidents at home,
using this evidence-based checklist.
Certainly we would not be, we're always looking
for partnerships with other foundations
and/or if they would like, we do sometimes get foundations.
The Foundation for Middle East Peace has given us grants
in the past, anywhere ranging up to 25,000.
That's where we get our money from.
Yes?
(Questioner speaks away from mic)
- Let's just be clear
what personalize the enemy means.
It means something like,
that if you see a five-year-old Syrian boy
who's got his head in the sand and he's dead,
as a measure of personalize the enemy,
that that could make an impact.
The reality is, neither that
nor this is gonna make an impact.
This will not make an impact to try
to bring American Jews together.
Whatever reason, it did work in the past.
Abu Ghraib did make an impact.
Abu Ghraib today, those of you who were too young
to remember what Abu Ghraib was,
is where Americans were filmed torturing
and photographed torturing Iraqi prisoners.
That actually made an impact.
Today, I don't know that it would make an impact.
The violence against Palestinians
or the violence against Israeli Jews doesn't make
the same impact that it did.
One could discuss that at length, but the reality is,
this kinda stuff, I can tell you, will lead to more
of this stuff, unless there is actions in leadership both
from Jews and others and from this administration.
This, by itself, will not move the needle.
I don't wanna end on that note, 'cause I'm Italian-Jewish,
so that must be optimistic. (laughs)
I know we don't have time, so is there one last question
that, I guess, is more hopeful? (laughs)
If not, I just wanna truly thank you.
It's one o'clock, and I know
that you've all got things to do,
and I really appreciate your coming.
If you wanna know more about Healing Across the Divides,
please sign your name with your email address
and I'll put you on a list,
and you can always delist yourself whenever you want.
Thanks again for coming.
(audience applauds)
- [Dr. Greene] If you're joining us for the Q&A,
we'll just gather-